Best Methods to Quit
 
The "5 A's"
Counseling Method
An easy-to-implement, evidence-based clinical counseling approach, the
"5 A's", has been recently developed and can double or even triple quit
rates among pregnant smokers. This approach has been published by the
U. S. Public Health Service in its Treating Tobacco Use and Dependence
Clinical Practice Guideline, and by the American College of Obstetricians
and Gynecologists. The approach is effective for most pregnant smokers,
including low-income women, the group most likely to smoke during pregnancy.
Studies show that a brief
counseling intervention of 5-15 minutes, when delivered by a
trained health care professional and augmented with
pregnancy-specific self-help materials, can double or, in some
cases, triple smoking cessation rates among pregnant
women.
The
evidence-based intervention for providers to help their pregnant
smokers quit is based on the following five steps (the "5
As"):
Ask
patient about smoking status.
A. I have NEVER smoked, or have smoked LESS THAN 100 cigarettes in
my lifetime.
B. I stopped smoking BEFORE I found out I was pregnant, and I am
not smoking now.
C. I stopped smoking AFTER I found out I was pregnant, and I am not
smoking now.
D. I smoke some now, but I cut down on the number of cigarettes I
smoke SINCE I
found out I was pregnant.
E. I smoke regularly now, about the same as BEFORE I found out I
was pregnant.
Provide clear, strong advice to quit with personalized messages
about the impact of
smoking on mother and fetus.
Assess the willingness of
the patient to make a quit attempt within the next 30 days.
Suggest and encourage the use of problem-solving methods and skills
for cessation.
Provide social support as part of the treatment.
Arrange social support in the smoker’s environment.
Provide pregnancy-specific, self-help smoking cessation
materials.
Periodically assess smoking status and, if she is a continuing
smoker, encourage cessation.
When the "5 A's" Approach
Isn't Enough
Pregnant smokers who are
unable to quit with the help of the 5As may benefit from
recommendations of the general PHS guideline. This guideline
recommends intensive counseling from a provider with special
training in the treatment of tobacco dependence; such intensive
counseling might help heavily addicted smokers to quit. The
guideline also advises providers to carefully consider use of
medications used to treat tobacco dependence in other populations -
nicotine replacement and bupropion - for pregnant women because
they have not been tested for safety and efficacy among this
population. Pharmacotherapies should be used only for pregnant
women who smoke heavily and are unable to quit using counseling
methods, and only when the potential benefits and likelihood of
quitting are likely to outweigh the potential risks.
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